PCOS患者三种促排卵方案的疗效比较

The Comparison among Three Ovulation Induction Effect on Patients with PCOS

目的:比较克罗米芬(CC)、人绝经期促性腺激素(HMG)、克罗米芬和人绝经期促性腺激素联合(CC+HMG)3种促排卵方案对多囊卵巢综合征(PCOS)患者的治疗效果。方法:选择2008年6月-2011年8月在我所生殖健康科就诊的PCOS患者154例。测定154例PCOS患者的基础内分泌,经联合应用达英-35和二甲双胍3～6个周期复查内分泌指标后,按用药方法的不同分为3组:CC组50例,HMG组52例,CC+HMG组52例。比较3组的年龄、绒毛膜促性腺激素肌注日(HCG日)血清E2水平﹑HCG日平均卵泡直径≥14mm的卵泡(成熟卵泡)个数、HMG用量﹑排卵率﹑妊娠率﹑卵泡未破裂黄素化(LUF)等。结果:154例PCOS患者经联合应用达英-35和二甲双胍后,血LH、睾酮(T)及LH/FSH较治疗前有明显降低,差异有显著性(P<0.01);3组患者年龄、HCG日成熟卵泡个数及血清E2水平比较,差异无显著性(P<0.05);CC+HMG组和HMG组比较,CC+HMG组HMG用量明显少于HMG组,差异有显著性(P<0.05);CC+HMG组妊娠率明显高于其他两组,差异有显著性(0.005<P<0.01)。3组患者排卵率和LUF比较差异均无显著性(P<0.05)。结论:PCOS患者使用CC+HMG促排卵方案可以获得满意的周期妊娠率,而且可以明显降低HMG的用量及并发症的发生。

Objective.. Comparison of clomiphene citrate （CC）, human menopausal gonadotropin （HMG）, clomiphene citrate and human menopausal gonadotropin （CC＋ HMG） combined for three ovulation induction of polycystic ovary syndrome （PCOS） in patients with therapeutic effect. Methods： From June 2008 to August 2011 in our reproductive health clinic in 154 patients with PCOS. Determination of 154 PCOS patients with endocrine basis, by the combined ap- plication of Diane-35 and metformin for three to six cycle review endocrine indicators, according to the administration methods are classified into three groups; 50 cases in CC group, 52 cases in HMG group, C＋HMG group. 52 cases. Comparison of 3 groups of age, serum Ez level on the day of human chorionie gonadotropin（HCG） intramuscularly, the numbers of mature follicles on the day of HCG injection, amount of HMG, ovulation rate, pregnancy rate, luteinized un- ruptured follicle syndrome（LUF） etc. Results： 154 cases of PCOS patients by combined application of Diane-35 and met- formin, blood LH, testosterone （T） and LH/FSH than before treatment is obviously decreased, there was a significant difference （P〈0. 01） ;in three groups of patients with age, the number of mature follicles and serum E,z level on the day of HCG injection, no significant difference （P-~0. 05）;C C＋ HMG group and HMG group, CCq-HMG group HMG was obviously less than group HMG, there was a significant difference （P^0. 05）; group CC＋HMG pregnancy rate was higher than the other two groups, the difference was significant （0. 005~P^0. 01）. In 3 groups of patients with ovulation rate and LUF were no significant differences （P〈0. 05）. Conclusion. The patients with PCOS using CC＋ HMG ovulation induction methods can get a satisfactory cycle pregnancy rate, but also can reduce the dosage of HMG and complications.